Testosterone Therapy: What Men Should Know

The effect of declining testosterone levels in men is well documented and accepted—low sex drive, low energy, increased fatigue, and decreased physical strength. However, treating testosterone deficiency can dramatically improve the quality of life and health of men in measurable ways based upon hundreds of recent scientific studies.

If some or many of these symptoms apply to you, schedule an appointment with our physicians to see if you might benefit from hormone therapy.

Treating Low Testosterone

There are several different ways to treat low testosterone; however, testosterone pellets are the ideal treatment for low testosterone since they provide a patient with a constant level of available testosterone sufficient to meet his/her optimal needs. Testosterone gels have issues with absorption and available levels being inconsistent throughout the day. Injections have issues with spiking peaks and valleys in hormone availability. Oral testosterone supplementation is not a viable option as it gets metabolized in the liver before it gets to the blood stream.

If you are an appropriate candidate for testosterone therapy (determined after baseline blood work and appropriate consultation), you will have a small area of skin at your waist line below the “love handle” area numbed with a local anesthetic. A small cut in the skin of about a 16th of an inch (3 millimeters) is made in the numb area. A tiny metal tube with a plunger then painlessly inserts the testosterone pellets into the deep fat where you won’t be able to feel it. A steri-strip skin tape is used to cover the small skin opening, which falls off in 4 or 5 days after the skin heals closed. For 5-7 days after the insertion, you should not do high impact activities or put direct pressure on the pellets. Early physical activity is a cause of “extrusion,” which is a pellet working its way out.

You can expect to feel some improvements with in the first week and almost everyone feels the difference within the first three months of therapy. Four weeks after your first insertion, you will be asked to get another blood test and then come in to discuss what you have experienced in symptom relief. We will decide whether any adjustment needs to be done to your future dosage based on your blood test and symptoms.

Men typically require insertion every four months, so you can expect to have 3 insertions in your first year of treatment. You can stop treatment at any time, which will cause your hormone levels to drift back to your pre-treatment levels and your pre-treatment symptoms to return.

Possible Side Effects

There have been studies in which healthy men were treated with large doses of bio-identical testosterone up to many times the “normal” blood level with no ill effects. In particular, all modern studies of behavior have shown NO increase in aggression with bio-identical testosterone when given to achieve therapeutic levels.

Muscle strength and size will modestly increase with testosterone therapy, which is further enhanced with weight training. You will not get muscularly huge or disproportionate from testosterone pellets.

Sperm counts drop significantly after a month of being on pellet therapy, but this should not be relied upon for birth control. This is reversible and sperm counts will return to your baseline six months after the last pellet insertion.

In most men, the red blood cell count will increase. In a small percentage of men, the red blood cell count will increase above the “normal” range as defined by the laboratories. Depending on your levels and other medical issues, it may be required that you donate blood at an interval determined best for you.

Hair loss may increase with testosterone therapy. The testosterone is converted into dihydrotestosterone (DHT) and it’s the DHT that causes the hair loss. Everyone is different as to how much DHT is formed in the body. There are treatments that can be prescribed to block this process and the hair loss will usually revert back to the previous rate of hair loss.

The most common side effects are bruising and bleeding which are usually infrequent and minor. Rare complications include: hematoma formation, extrusion of the pellets, and infection.